No pound-shedding panacea

The Oscar goes to… Ozempic!

Heard of it? (I’m sure you have). Even host Jimmy Kimmel got in the act during his opening monologue at the Academy Awards on March 12.

“Everybody looks so great. When I look around this room, I can’t help but wonder ‘Is Ozempic right for me?’”

(It’s a running joke that everyone in Hollywood is using it)

So, is it right for you?

Ozempic is an injectable medication administered once a week. Generically known as semaglutide, an anti-diabetic drug, Ozempic mimics the GLP-1 hormone naturally produced in the intestines. Also known as glucagon-like peptide 1, this hormone works with the pancreas to release insulin and balance blood glucose levels.

Its primary role is to reduce food cravings and appetite. It can also delay gastric emptying, which is the time it takes for food to move through the stomach, so you hit and sustain that full feeling more than normal.

Appetite can be a major deterrent for many dieters looking to shed pounds. For some clients, their appetite is ravenous with the slightest calorie drop and no amount of “willpower” helps. No doubt there’s a genetic component at play here. Plus, being overweight and overfed for a long while can “break” some of the internal hardwiring that regulates how much we eat.

Some well-intentioned people are constantly bombarded with “hangry” signals (those commercials aren’t wrong) or thoughts of eating, while others can go their entire workday without thinking about food. Ozempic can dampen those hunger signals in those who struggle to manage.

This isn’t a magic drug. You’ll still need to implement a diet and exercise program. But many people find it difficult to stay consistent with a diet because of relative hunger, social environment and genetics. For those struggling, this drug (and others like it) help take the stress away from eating.

So, all good so far, right? One thing to note is the prohibitive cost, side effects and potential weight rebound afterwards.

Depending on dose, a one-month supply of Ozempic can cost patients between $250 and $1,000 without insurance coverage. And it’s only covered for Type 2 diabetics in Canada at the moment.

The same semaglutide is branded as Wegovy in the U.S. and prescribed for weight loss, and may soon be widely available north of the border.

Why is it so popular south of the border? A big promotional push — just like the one here — is at play. It also has celebrity endorsements. Elon Musk wrote on Twitter that he was taking Wegovy and implementing fasting to drop the weight people had noticed he lost.

In January, comedian Rosie O’Donnell said she had lost 10 pounds since Christmas by taking tirzepatide (a newer version in the same class of drugs available in the U.S.). O’Donnell said in a series of TikTok videos that her appetite significantly decreased and she spends less time thinking about food.

OK, but what about those side effects?

The most common are nausea, vomiting and diarrhea, but tend to subside over time and vary by individual. However, they will also reappear if the dose is increased.

Some people taking semaglutide may notice less fullness in their face. In fact, this phenomenon has been referred to as “Ozempic Face.” This can also result in looser skin and wrinkles that become more noticeable. But rapid weight loss without drugs could cause similar outcomes.

There’s a small risk of pancreatitis and thyroid cancer, according to the medication’s standard disclaimer (there was a signal in studies on rats, but humans have different cells in our thyroids so it’s remote at this point).

What happens after you stop?

One study published last April in the journal Diabetes, Obesity and Metabolism showed one year after discontinuing use of semaglutide, participants regained two-thirds of the weight they lost while on the drug.

This may be a drug you have to take forever to manage weight, just like one would do to manage blood pressure. Some may be able to wean off if they develop healthy habits to keep the weight off. Either way, this isn’t a quick fix you use for a month before a vacation and then drop.

Another downside is the “quality” of the weight lost. Two separate clinical trials for semaglutide showed roughly 40 per cent of the total weight loss experienced by patients was lean muscle, not just fat.

Though there’s limited research on this so far, I’d suggest you could change that by incorporating strength training, cutting calories slowly and eating sufficient protein. The same losses of lean muscle are common in dieters who lose weight quickly through diet changes alone. Your body will “eat up” muscle along with fat if you don’t give your muscles a reason to stick around.

And we know not all weight loss is healthy. While shedding excess fat (and in particular, visceral fat) has a multitude of beneficial effects on health, shedding lean mass — which includes muscle and bone — is associated with poorer health and reduced lifespan.

The goal of any fitness program is to increase the body’s overall proportion of muscle — while dropping fat. That’s why you cannot rely solely on semaglutide or any weight-loss drug — they are not magic interventions.

In a perfect world, should you explore this further, you’d focus on instilling habits built to last while using the drug to support adherence in the early going. Those critical habits include strength training, stress management, sustainable dietary changes, regular movement and mindset work.

If you do not build and maintain a solid fitness routine during and after the use of semaglutide, you will have a hard time keeping the weight off. The followup studies highlight this. If you closely read the abstract from the followup study, it refers to “withdrawal of once-weekly subcutaneous semaglutide 2.4 mg and lifestyle intervention.” Lifestyle intervention is the X-factor. Ultimately, you can’t stay fit without building and keeping up the habits of a fit person. Nothing works until you embrace that reality. But drugs like Ozempic — assuming you can tolerate the side effects and cost — may help you get started and keep going once you do.

I must stress that the medical information in this column is provided as an informational resource only, and is not to be used or relied upon for any diagnostic or treatment purpose. This information should not be used as a substitute for professional diagnosis and treatment.

Please consult your health-care provider before making any health-related decisions and for guidance regarding any specific medical condition.

Mitch Calvert is a Winnipeg-based fitness and mindset coach. Apart from his column in the Winnipeg Free Press, he’s been featured in Men’s Health. Visit mitchcalvert.com to grab a free copy of his metabolism jumpstart crash course or contact him directly for coaching opportunities.